Occupational asthma

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Evidence last reviewed: 21 Apr 2026

Topic last updated: 15 Aug 2025

Occupational asthma (OA) should be suspected in all adult patients with asthma.

Occupational history may identify work-related causes. Details of work exposures should be obtained from material safety data sheets available to the patient from their workplace.

Objective evidence of asthma should be obtained from spirometry, a bronchodilator response, and/or a methacholine challenge. Tests should be performed when the patient is symptomatic and/or within days of exposure to a suspected etiologic agent.

In sensitizer-induced OA, removal from any further exposure to that agent is recommended if an immunologic response to the work sensitizer is demonstrated by skin or in vitro tests.

In irritant-induced OA, preventive measures should be implemented in the workplace to reduce future exposures and episodes.

For all causes of OA, the clinician should continue treating the asthma as appropriate, assist in the initiation of any appropriate compensation claim, and consider other workers at risk.

Definition

OA is asthma caused by the workplace and may result from immunologic or nonimmunologic stimuli.[1]

Sensitizer-induced OA is caused by immunologic stimuli and develops after a latency period between first exposure and the onset of symptoms.[2][3] Irritant-induced OA (including reactive airways dysfunction syndrome) is caused by nonimmunologic stimuli.[4]

Anamnesis y examen

Principales factores de diagnóstico

occupational exposure to sensitizing agents or irritants
symptoms of asthma that improve during holidays
initial onset of asthma symptoms during a work period

Todos los datos

Factores de riesgo

high-level exposure to sensitizer
atopy
genetic factors
smoking

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

spirometry
chest x-ray
skin prick testing (SPT)
nonspecific bronchial hyper-responsiveness (NSBHR)
serial peak expiratory flow (PEF)

Todos los datos

Pruebas diagnósticas que deben considerarse

specific serum IgE assay
specific inhalation challenge (SIC)

Todos los datos

Pruebas emergentes

induced sputum cytology
fractional exhaled nitric oxide (FeNO)

Algoritmo de tratamiento

Agudo

sensitizer-induced

irritant-induced

En curso

symptomatic asthma

Colaboradores

Autores

Ryan Hoy, MB BS, MOEH, FRACP

Respiratory Physician

The Alfred Hospital

Melbourne

Victoria

Australia

Divulgaciones

RH is an author of a reference cited in the topic.

Susan M. Tarlo, MB BS FRCP(C)

Professor of Medicine

University of Toronto

Respiratory Physician

Toronto Western Hospital

Toronto

Ontario

Canada

Divulgaciones

SMT has received grant support from the Ontario Workplace Safety and Insurance Board (WSIB) and the Centre for Research Expertise in Occupational Disease (funded by Ontario Ministry of Labour). She has acted as a consultant for the Ontario Workplace Safety and Insurance Appeals Tribunal (WSIAT) and has provided clinical case assessments for WSIB. She has been a member of Task Forces for the European Academy of Allergy, Asthma and Clinical Immunology and an expert advisor to a committee of the European Respiratory Society. She is a member of the Occupational Disease Committee of the American Academy of Allergy, Asthma and Clinical Immunology (AAAAI). She has been an invited speaker at meetings of AAAAI and the American Thoracic Society. She is a coeditor of Current Opinion in Allergy and Clinical Immunology, and has received book royalties as coeditor of Asthma in the Workplace. SMT is an author of references cited in the topic.

Revisores por pares

Ware Kuschner, MD

Associate Professor of Medicine

Stanford University

Stanford

Staff Physician

US Department of Veterans Affairs

Palo Alto Health Care System

Palo Alto

Divulgaciones

WK declares that he has no competing interests.

Karin Pacheco, MD

Associate Professor of Medicine

National Jewish Medical Centre

Denver

Divulgaciones

KP declares that she has no competing interests.

Philip Harber, MD

Professor of Medicine

University of California

Los Angeles

Divulgaciones

PH declares that he has no competing interests.

Agradecimiento de los revisores por pares

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Divulgaciones

Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.

Referencias

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Artículos principales

Barber CM, Cullinan P, Feary J, et al. British Thoracic Society clinical statement on occupational asthma. Thorax. 2022 May;77(5):433-42.Texto completo Resumen

Tarlo SM, Balmes J, Balkissoon R, et al. Diagnosis and management of work-related asthma: American College Of Chest Physicians Consensus statement. Chest. 2008 Sep;134(3 suppl):1S-41S. Resumen

Baur X, Sigsgaard T, Aasen TB, et al. Guidelines for the management of work-related asthma. Eur Respir J. 2012 Mar;39(3):529-45.Texto completo Resumen

Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. May 2025 [internet publication].Texto completo

American College of Radiology. ACR appropriateness criteria: occupational lung diseases. 2019 [internet publication].Texto completo

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
- Work-exacerbated asthma
- Occupational eosinophilic bronchitis
- Coincidental nonoccupational asthma
Más Diferenciales
Guías de práctica clínica
- Global strategy for asthma management and prevention
- Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN)
Más Guías de práctica clínica
Folletos para el paciente
Asthma in adults
Más Folletos para el paciente
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Occupational asthma

Summary

Definition

Anamnesis y examen

Principales factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Pruebas emergentes

Algoritmo de tratamiento

sensitizer-induced

irritant-induced

symptomatic asthma

Colaboradores

Autores

Ryan Hoy, MB BS, MOEH, FRACP

Divulgaciones

Susan M. Tarlo, MB BS FRCP(C)

Divulgaciones

Revisores por pares

Ware Kuschner, MD

Divulgaciones

Karin Pacheco, MD

Divulgaciones

Philip Harber, MD

Divulgaciones

Agradecimiento de los revisores por pares

Divulgaciones

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Folletos para el paciente

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión para acceder a todo el BMJ Best Practice